General Trip Application – Ann Prepare Lavni

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Step 1 of 3

Person Info
Name*
As it appears on your passport
First Middle Last
Phone*
Email*
Gender*
Date of Birth*
MM slash DD slash YYYY
T- Shirt Size*
Travel Info
Passport Number*
Passport Issued Date*
MM slash DD slash YYYY
Passport Expiration Date*
MM slash DD slash YYYY
Passport Issuing Country*
Country
Nationality*
Passport Image*
Please upload a clear, readable photo page of your passport page.
Max. file size: 128 MB.

Questionnaire
Where did you hear about Ann Prepare Lavni?
Please list the specific person or organization
Have you traveled outside the continental U.S. before?
If so, when/where?
Why are you interested in going on this trip?
Please list your personal skills, gifts, talents and abilities.
Do you sing, dance, build, teach, have medical skills?
Are you able to endure the high temperatures in Haiti/Dominican Republic?
Please note if you have ever had heat stroke or any issues from being in hot temperatures.
Additional Information
Social Media Accounts URLS (Twitter, Instagram, Facebook)
So we can share/tag you with your permission
Do you currently sponsor a child through ANN PREPARE LAVNI?*
If you intend to sponsor a child and would like to meet them on this trip, we encourage you to sign up for sponsorship as far in advance as possible, so that the child can be in the program before you travel to Haiti/Dominican Republic
- Yes
- No
Agreements
I will keep ANN PREPARE LAVNI updated through Managed Missions and email of any changes in MEDICAL CONDITIONS, MEDICATIONS, ADDRESS, PHONE #, EMAIL ADDRESS, PASSPORT INFO. etc. This is especially important to provide ALL medical conditions you have and medications/dosages you take. Our Medical Staff and Trip Leaders need this in case you need Medical Treatment when traveling with us. Please keep this updated.
- I agree
I will submit all funds to ANN PREPARE LAVNI as required and on schedule
- I agree
If for some reason I cannot keep my commitment to this trip I recognize I am still responsible for my flight and any other trip finances that I owe the team
- I agree
If there is a weather-related delay while traveling and the airline does not cover expenses I will be responsible for any extra costs involved such as hotel, food and transportation
- I agree
I recognize that my deposit is non-transferrable and non-refundable
- I agree
I will read, sign and send (email, snail mail, fax) my personal Covenant, Waiver and Release, and Team Contract to ANN PREPARE LAVNI
- I agree
I will submit to the leadership of ANN PREPARE LAVNI before and during my trip to Haiti/Dominican Republic for safety and unity of myself and the team
- I agree

Support APL

Step 1 of 3

Person Info

Travel Info

Primary Emergency Contact

Secondary Emergency Contact

Additional Information

Questionnaire

Additional Information

Agreements